Workers Compensation and Claims Administration and Excess Insurance Services

The vendor is required to provide workers compensation and claims administration and excess insurance, as well as from organizations offering both services.
- The city budget includes funding for 554 full-time employees and 130 permanent part-time employees who deliver a variety of public services.
1. Workers’ compensation claim administration services
•    Provider will oversee and manage the self-insured workers’ compensation program for the city.
•    The services provided will include, but are not limited to, handling medical-only cases, lost time claims, litigated cases, mediation, rehabilitation, small claims processing, subrogation, and the preparation and distribution of necessary notices and reports associated with these services.
•    Provider will be responsible for calculating the average weekly wage, determining weekly indemnity rates, and issuing payments for medical expenses, indemnity, and claims related to the city’s self-insured workers’ compensation program.
•    Banking and funding arrangements will be established in collaboration with the successful service provider. 
•    The third-party administrator (TPA) will oversee all matters related to the city of sterling heights’ defense in workers’ compensation claims. 
•    The chosen service provider will manage all assigned claims that occur within the contract period until their resolution, for an agreed-upon per-claim or annual fee.
•    Provide the city with reports detailing the total costs and expected expenses for the life of each claim, which can be submitted monthly.
2. Workers’ compensation excess insurance services
•    Provide the excess workers compensation services for the city. 
•    Provider will handle claims management for the city.
•    Providers with experience in excess insurance services and claims management should outline, in writing, how they can deliver the required services.
- Claims administration
•    Assignment of claims personnel and communication procedure with the client, TPA, as well as with the injured employee.
•    Creating and maintaining proper reserves for each claim.
•    Arranging for the employee to undergo an independent medical examination.
•    Pursuing subrogation on behalf of the city.
•    Determining when and how to assign a medical case manager.
•    Adhering to the requirements outlined in the city collective bargaining agreement.
•    Negotiating and settling claims when applicable.
•    Ensuring compliance with reporting and various other requirements set forth whether by the city, the TPA, and federal and state obligations.
o    Ensuring compliance with the TPA requirements, city requirements, as well as federal and state reporting.

- Contract Period/Term: 2 years